Exhibit 12
Form SB-2
e Nutrition, Inc.
E NUTRITION, INC. - COMMON STOCK
SUBSCRIPTION AGREEMENT
Investment
I desire to purchase shares of e
Nutrition, Inc at $0.20 per share for a total of $
Make Checks Payable to: Brighton Bank , e Nutrition, Inc., Escrow Account
Subscriber Information: Please clearly print name(s) in which Shares are to be
acquired. All correspondence will go to the Investor Residence Address
Investor 1 (First, Middle I., Last):
Investor 2 (First, Middle I. Last):
REGISTRATION FOR THE INVESTMENT (HOW THE INVESTMENT SHOULD BE TITLED):
INVESTOR RESIDENCE ADDRESS 1: CHECK ONE OF THE
FOLLOWING:
U.S. Citizen
Investor Residence Address 2:
Resident Alien
City, State ZIP Code Foreign
Resident; Country ________
U.S. Citizen residing outside
the U.S.
Enter the taxpayer identification number. For most individual taxpayers, it is
their Social Security Number. Note: If the purchase is in more than one name,
the number should be that of the first person listed. For IRAs, Keoghs, and
qualified plans, enter both the Social Security Number and the Taxpayer
Identification Number for the plan.
SOCIAL SECURITY NUMBER TAXPAYER IDENTIFICATION NUMBER (IF
APPLICABLE)
Form of Ownership (Individual, XXX, Trust, UGMA, Pension Plan, etc.)
Subscriber Signature: The undersigned has the authority to enter into this
subscription agreement on behalf of the person(s) or entity registered above.
Authorized Signature of Investor 1 ________________________________________
Date:_____________________________________
Authorized Signature of Investor 2
________________________________________
Date:_____________________________________
Company's Acceptance (To be completed only by an authorized representative of
the Company.)
The foregoing subscription is accepted this ____________ day of
________________, _____
___________________________________
Authorized Representative of the
Company
E-31
